| NPI | 1548451917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401417375) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417375) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2025-06-17 |